Excelling at sports and other athletic endeavors requires a broad set of physical skills and abilities that should be sharpened to achieve optimal performance. Among these is the ability to quickly change direction, which is considered essential for a number of fast–paced sports. It therefore follows that the most elite athletes tend to consistently demonstrate faster change of direction times compared with less elite athletes. Research has even suggested that targeting certain movements that lead to faster change of direction times can also reduce the risk for ACL injuries.

For these reasons, there has been increased attention into finding ways to improve change of direction performance. Resistance training—which involves the use of weights, bodyweight, or resistance bands to build strength—has been identified as an effective way to improve change of direction performance, but some sports organizations are hesitant to adopt these types of programs because they believe it may lead to increased soreness and muscle damage in athletes. In addition, resistance training programs typically require extended periods of time to provide the intended benefits, which can make it difficult to incorporate them into training programs.

Trainers and researchers have therefore been looking into alternative training methods to improve change of direction, which may translate to better performance and lower injury risk. In particular, they want to know what interventions increase either pre–planned agility—the ability to respond to expected external stimulus by braking as quickly as possible and then accelerating in a different direction—or reactive agility, which is the same motion but with a stimulus that is not expected. However, there is not much evidence supporting alternative methods for improving change of direction in the literature.

Scoping review suggests that addressing kinetic and kinematic variables may improve change of direction performance

With this in mind, a study called a scoping review was conducted to identify any other effective approaches that lead to better change of direction skills. To conduct the review, researchers performed a search of four medical databases for peer–reviewed studies that evaluated the effect of targeted interventions on change of direction in adult competitive athletes. A total of 53 studies were deemed eligible for inclusion in the review, and investigators analyzed their findings in search of patterns and trends.

Most of the studies include in the review (81%) investigated strength and/or power for improving change of direction, and the exercises that led to the greatest improvements included the broad jump, squat, squat jump, mid–thigh pull, deadlift, and eccentric hamstring strengthening exercise. Strength and/or power training led to an average improvement in pre–planned change of direction performance by 3.4%, and the average training time was 8.5 weeks.

But other interventions were also identified that may lead to similar or greater improvements than strength and power. Nine studies (17%) investigated the relationship between kinetic or kinematic variables and change of direction—most of which focused on pre–planned change of direction. They found that several variables were strongly related to change of direction performance, including increased velocity at specific points during a cutting maneuver, shorter ground contact time, and greater ankle power. There were also two studies that used alternative training interventions to improve change of direction performance, which reported improvements of 5.1% in pre–planned change of direction and 5.8% in reactive agility performance.

These findings suggest that there may be several variables other than strength and power that could improve change of direction performance in short training periods. In particular, certain kinematic cues can be incorporated into change of direction activities that could encourage performers to adopt beneficial kinematics during a direction change.

Trainers and researchers should take note of this study and consider its findings when designing training programs with the intention of optimizing performance and reducing injury risk. In the meantime, if you're dealing with any painful issues that are preventing you from performing at your best, we encourage athletes to contact us and schedule an appointment with one of our physical therapists.

For individuals over the age of 75 or 80, thinking about falling can occupy a great deal of mental energy and lead to excessive fear of movement in the process. This is completely understandable, as falls are the leading cause of injury for older adults and the odds of suffering from a fall increase as one gets older. Approximately 40% of older adults living at home experience one fall per year, and this figure is even higher for adults living in nursing homes and assisted living facilities.

One of the most effective strategies to reduce this risk of falling is for older adults to use a walking aid like a cane or front–wheeled walker at all times. These devices assist with upright balance and mobility, which are essential for avoiding a fall; however, some research has suggested that using a walking aid may also increase the risk for falling in some individuals. This may seem counterintuitive, but is likely because certain adults do not use the devices properly, usually from a lack adequate guidance.

Study highlights the potential dangers of assistive devices

With this in mind, a study was conducted to investigate the advantages and possible disadvantages of using canes and walkers. Researchers performed a search of two major medical databases for studies that evaluated the use of single–tip canes and pickup walkers for their benefits related to falls/injuries or other physical demands. This search led to more than 1,000 studies being identified, and about 10% of these were included in the review.

Upon review, researchers determined that there was ample evidence to indicate that canes and walkers can improve balance and mobility in older adults and patients with certain clinical conditions. However, researchers also identified several studies showing that a large proportion of individuals do experience difficulty when handling assistive devices, and this improper usage increases their risk of falling. For example, the act of lifting a cane or walker can have a destabilizing effect by potentially disturbing the user’s center of mass, but this can be countered by making certain adjustments to their posture.

This highlights the need for proper guidance when an older adult is first given an assistive device to ensure that they are using it correctly and to reduce their risk for falling. Physical therapists are experts in the proper use of walking aids, and we strongly recommend that you see a physical therapist for specific instructions and to answer any questions you might have about their use. To give you a general overview of what this type of session will entail, the following tips cover some of the primary points that we’ll focus on.

5 tips to ensure the proper use of an assistive device

1. Use proper positioning when holding your cane
   • The cane should always be held in the hand of the stronger leg
     • This means if your right leg is stronger than your left leg, hold your cane in the right hand and advance it forward when the left leg steps forward
   • When standing up straight, the top of your cane should reach to the crease in your wrist, and your elbow should be slightly bent when holding the cane
2. Up with the good, down with the bad
   • When going up stairs with a cane, step with the stronger leg first while holding onto the railing
   • Once that foot is on the stair, step up with the weaker leg
   • This allows the stronger leg to do most of the work to push the body up the stair while leaving minimal work for the weaker leg
   • When coming down stairs, step with the weaker leg first while holding onto the railing
   • Once that foot is on the stair, step down with the stronger leg

3. Use proper positioning with your back straight
   • When standing up straight, the top of your walker should reach to the crease in your wrist and your elbows should be slightly bent when you hold the handgrips of the walker
   • Keep your back straight and don’t hunch over the walker
4. Keep your body aligned with the walker when walking
   • Be sure to keep the front of your body in line with the back two posts of the walker before moving the walker
   • Advance the walker a few inches in front of you first, and make sure and make sure all tips and wheels are touching the ground before taking a step
   • Step forward with your bad leg first, then step forward with your good leg, placing it in front of your lead foot
5. Other
   • Make sure the rubber tips on your walker’s legs are in good shape and replace them if they are worn out
   • Take your time and never rush when using these devices
   • If you don’t feel comfortable using a cane with a single point, let someone know; a quad cane or walker may be more appropriate for you

While these tips should serve as good reminders, we can’t emphasize enough the importance of seeing a physical therapist for hands–on guidance. Therefore, we encourage you to schedule an appointment with one of our therapists today to learn the proper way to use your assistive device.

Neck pain is a rather common nuisance. About 10–20% of the population is dealing with it right now, and up to 70% of individuals will encounter it at some point in their lives. When neck pain strikes, it can prove to be troublesome and place a strain on everyday life, making simple movements like bending over to pick an item off the ground or twisting your torso a major challenge. Over time, the inconvenience of neck pain and movement limitations will often lead patients to wonder why they’re experiencing the pain and what steps can be taken to address it.

Physical therapy is among the most reliable and beneficial interventions for neck pain, and most treatment programs revolve around various stretching and strengthening exercises for the neck. Research has also shown that aerobic exercise—or “cardio,” which is any physical activity that increases your heart rate and the body’s use of oxygen—is effective for chronic back pain, chronic fatigue, fibromyalgia, and many other conditions, and it may therefore alleviate neck pain as well; however, research specifically investigating aerobic exercise for neck pain is lacking.

Aerobic exercise added to an exercise therapy program to assess potential benefits

Therefore, a study was conducted to determine if adding aerobic exercises to neck–specific exercises is effective for relieving neck pain and disability. Researchers recruited patients with a primary neck pain complaint who were referred to a physical therapy clinic, then screened these individuals to determine if they were eligible to participate. This process led to 139 patients being included in the study, who were then randomly assigned to either the control group or the experimental group.

Patients in the control group completed two sessions of treatment per week for six weeks, with each session consisting of various neck–specific stretching and muscle performance exercises. Patients in the experimental group underwent the same neck–specific exercise program as the control group, but also completed aerobic cycling in every session. The patients cycled on a stationary bike at a moderate pace—60% of their maximum heart rate—for 20 minutes during the first week, 30 minutes during the second week, and 45 minutes for the third week until the sixth and final week. All participants were evaluated at the start of the study, after completing the six–week interventions, and then again three and six months later for several variables related to neck pain and disability, as well as headache complaints and patients’ beliefs about the influence of work and activity on their neck pain.

Results showed that patients in both groups reported less pain after the six–week interventions, but the reductions were more significant for patients in the experimental group. In addition, only patients in the experimental group experienced further reductions in neck pain at the three– and six–month follow–ups. There was also a significant reduction in a measure that assessed pain, disability, and fear of movement in both groups, but the reduction was significantly higher in the experimental group than the control group. Finally, the experimental group reported better neck range of motion and fewer headaches compared to the control group. Further analysis also revealed that the longer the duration of aerobic exercise, the greater the chances of a successful outcome over time.

These findings show that neck–specific exercises lead to various improvements in patients with neck pain overall, with most patients experiencing neck pain relief and a reduction in headaches. Adding aerobic exercise to this treatment plan led to some additional benefits immediately after these interventions, and the improvements were even more significant in the long term, with less pain and disability at these time points. Therefore, patients with neck pain are strongly encouraged to see a physical therapist for their condition, where the therapist can design a personalized treatment program that includes various neck–specific exercises and possibly some aerobic training as well.

We spend about one–third of our lives sleeping, and our habits in the night can have a big impact on how we feel during the day. Sufficient sleep is an essential component of good overall health, as getting between 7–9 hours of sleep every night is associated with countless benefits, including lower stress levels, a reduced risk for many chronic disorders, improved memory and cognitive function, and possibly even a longer lifespan.

The implications of not getting enough sleep are widespread, and new associations continued to be identified regularly through research. Among these recently discovered associations are burnout and low back pain, as an increasing number of studies have suggested that poor sleeping patterns may increase the likelihood of both issues. In essence, sleep debt that accumulates from poor nighttime habits increases emotional exhaustion, which can in turn lead to an increase in muscle tension as part of the stress response, and this is linked with low back pain. However, there is a lack of research studying low back pain and burnout over time to disentangle the relationship between the two issues and determine the role of sleep problems in preceding them.

Researchers track more than 400 patients for three years

Therefore, a study was conducted to investigate the connection between sleeping habits, burnout, and low back pain in healthy individuals. Researchers screened 1,833 individuals to determine if they were eligible and only included those who did not report low back pain and/or burnout, which resulted in a final sample of 405 participants. At the start of the study, these individuals were asked to assess the quality of their sleep by answering the following questions:

• “In the last four weeks, how well did you sleep?”
• “Did your sleep problems have any effects on your tiredness during the day?”

Low back pain was similarly assessed with a series of questions about the presence, intensity, and location of any back pain, while burnout was assessed with questions that addressed the three dimensions of burnout: emotional exhaustion, depersonalization, and reduced performance. Participants then went about their lives and were assessed with the same questions about sleep quality, low back pain, and burnout 24 months and 36 months later, and their responses were analyzed at these follow–ups to tease out any connections between the three factors of interest.

Results showed that there were positive associations between all three factors, as having sleep problems at the start of the study was predictive of both low back pain and burnout in the future. In addition, participants who reported low back pain at the 24–month follow–up were more likely to report burnout at 36–month follow–up. Lastly, sleep problems were found to be a stronger risk factor for burnout than for low back pain, and this link was strongest in women 45 and older.

Although this study does not prove that sleep problems directly cause low back pain or burnout, it suggests that low back pain and burnout are more likely to occur in individuals who don’t regularly get enough sleep. As such, these findings serve as additional evidence that sleeping habits have widespread implications on many other areas of our health over time. We therefore encourage you to prioritize your sleep and aim to get at least 7 hours per night, as often as you can. And if you’re interested in learning some tips to help improve your sleeping habits, our physical therapists can help. Contact us for more information.

As physical therapists, we care deeply about all aspects of our patients’ health. This includes exercise habits, diet, and alcohol consumption, all of which contribute to one’s overall health in complex and interconnected ways. With this in mind, we wanted to describe a recently published study on the relationship between alcohol intake and long–term risk for death, whose findings have been making headlines and gaining the attention of the public.

You’ve probably heard that consuming small or moderate amounts of alcohol regularly is beneficial for your health and there’s a good reason why. A great deal of research has shown that people classified as “moderate drinkers” have longer life expectancy and are less likely to die from heart disease than those classified as abstainers. But a large amount of recent evidence has suggested that these associations could be due to certain biases that affected the findings of these studies. For example, light and moderate drinkers tend to employ many healthy behaviors, while abstainers tend to have poorer health, and failing to account for these differences can lead to data being misinterpreted.

Researchers perform updated systematic review and meta–analyses

Therefore, a powerful study called a systematic review with meta–analyses was conducted to address these questions and investigate the association between alcohol use and all–cause mortality risk. Researchers were also interested in determining whether any sources of bias affected this relationship.

This study was an update of previous systematic reviews and meta–analyses, which was accomplished by including recent studies published up to July 2021 that investigated the association between alcohol consumption and all–cause mortality. This search led to 107 studies published between 1980 to 2021 being identified, which included data on 4,838,825 patients and 425,564 deaths. Researchers then analyzed data from these studies on all–cause mortality, measures of alcohol consumption, study characteristics, types of misclassification errors, and controlled variables to tease out answers to their questions.

After adjusting for potential sources of bias, analysis of these 107 studies showed that occasional or moderate drinking was not associated with any significant protective effects from death of any cause. In addition, the risk of death from any cause was increased in those who drank 25 g of alcohol (about 2 drinks) or more per day, and this risk was significantly increased in those who drank 45 g (about 4 drinks) or more daily. Researchers also found that misclassification errors were common, as 86 studies included former drinkers and/or occasional drinkers in the abstainer reference group and only 21 studies were free of these biases. If these misclassification biases were not controlled for, it could have led to a different interpretation of the data, since former drinkers have significantly elevated mortality risk compared with lifetime abstainers. Future studies should therefore focus on minimizing these biases by not including former and occasional drinkers in the reference group and by using younger patients that are more representative of drinkers in the general population.

These findings suggest that despite the long–sustained narrative that consuming small or moderate amounts of alcohol is a healthy behavior, a closer examination of the research instead shows that it does not appear to offer any protective benefits against death from any cause, and that larger amounts of alcohol increase the risk of death. Therefore, we recommend that you consider this information when determining whether you should drink alcohol and how much to consume, but we also acknowledge that alcohol can alleviate stress for some individuals—something that this study did not investigate.

Falls are undoubtedly the greatest threat to the health of older adults, as they represent the leading cause of non–fatal injuries responsible for hospital admissions and death in this age group. About one–third of adults over the age of 65 and one–half of adults over 85 will fall at least once each year, which leads to approximately 2.8 million ER visits, 800,000 hospitalizations, and 27,000 deaths annually. In addition, about 20–30% of falls cause moderate to severe injuries that have a significant impact on one’s functional mobility and independence, which makes them a top priority in healthcare.

Falls occur in older adults due to a combination of both nonmodifiable and modifiable risk factors. Nonmodifiable risk factors are those that one is unable to control or change, including their age, sex, race, having a history of prior falls, and having certain chronic conditions. Modifiable risk factors are those that can be altered, and there are many modifiable risk factors associated with falls, including one’s balance, muscle strength, mobility deficits, and the fear of falling. Another extremely important modifiable risk factor is medication usage, as certain medications and combinations of medications are known to increase the risk of falling.

With this in mind, a study was conducted to examine the relationship between certain prescription medications and the risk of sustaining a secondary fracture after an initial fracture. Investigators were also interested in whether having one fracture influences if doctors change their prescribing behaviors for drugs that either increase or decrease fracture risk.

Researchers examine the medical records of 168,133 Medicare beneficiaries

To conduct the study, researchers used Medicare data to identify beneficiaries who were living in assisted living facilities and who survived a fracture of the hip, shoulder, or wrist over a span of four years. Researchers then devised a list of 21 drug classes that are associated with an increased risk for fractures—including benzodiazepines, antidepressants, and anti–Parkinson disease drugs—and analyzed the use of these drugs within 120 days of the fracture to determine if there was any connection between their use and suffering a fracture.

A total of 168,133 patients with a fracture met the necessary criteria and were included in the study, with the average age of these patients being 80 years. Of the included patients, 76% were exposed to at least one non–opiate drug associated with an increased risk of fracture in the 120 days prior to the date of the fracture, and this finding was consistent across all fracture types. More than half of these patients (55.7%) were taking at least one drug that increases fall risk prior to the index fracture while 42.2% were taking at least one drug that decreases bone density. After the initial fracture, there were only minimal changes in the proportion of patients who continued taking drugs associated with an increased fracture risk, and most patients continued to fill the same number of prescriptions for high–risk non–opiate drugs after their index fracture. Finally, the use of drugs that decrease fracture risk was low, with less than one–quarter of patients filling a prescription for a drug that increases bone density in the 120 days prior to their initial fracture.

These findings show that the use of drugs associated with an increased risk for fracture is common in Medicare beneficiaries, which means that these drugs can be considered a key modifiable risk factor for preventing fractures. In addition, suffering a fracture does not seem to consistently affect patients’ exposure to potentially risky drugs, as most continued to be prescribed these high–risk drugs in the aftermath of their initial fracture.

This study should serve as a wake–up call for healthcare providers who treat older patients to be extremely careful about what drugs they prescribe, especially if a patient experiences a fall–related fracture. Older adults and their caregivers should also be more cognizant of the potential risks associated with each drug individually and how they interact with other drugs by asking their prescribing physician before taking any new medications. We also strongly advise older patients who would like to reduce their risk for falls to consider seeing a physical therapist, who can help address other modifiable risk factors by improving their strength, balance, and mobility.

Physical activity is essential for maintaining optimal overall health and exercising regularly is known to reduce the risk for heart disease, diabetes, depression, some cancers, and numerous other health–related issues. Yet despite this, it’s estimated that over three million people worldwide die prematurely each year because they are not getting enough physical activity.

One important factor that contributes to this issue is that many individuals spend a large portion of their days sitting, which is called a sedentary lifestyle. Following a sedentary lifestyle and sitting for too much time each day is now recognized as a dangerous habit that can lead to a variety of health problems, including obesity, heart disease, diabetes, and cancer. Evidence even suggests that individuals who are physically active and meet the recommended guidelines for activity are still at risk for certain health complications if they spend too much time sitting.

Researchers conduct a study to examine the effects of occasional breaks from sitting

Physical activity guidelines typically make general recommendations for individuals to reduce their sedentary time, but they have not yet provided specific guidance on how often and how long sedentary time should be interrupted. With this in mind, a study was conducted to investigate whether taking occasional breaks from sitting had an effect on heart– and metabolism–related risk factors, and if so, how these effects changed with varying frequencies and durations.

Researchers selected 11 middle– and older–aged adults to participate in the study and instructed them to complete each of the following 8–hour conditions on 5 separate days:

• One uninterrupted sedentary condition (control intervention)
• Four acute trials that involved different frequency/duration combinations of sedentary breaks, which involved light–intensity walking (experimental intervention):
  • Sedentary breaks every 30 minutes for 1 minute each
  • Sedentary breaks every 30 minutes for 5 minutes each
  • Sedentary breaks every 60 minutes for 1 minute each
  • Sedentary breaks every 60 minutes for 5 minutes each

After each patient completed one intervention, they switched and completed the other intervention. Glucose levels were measured every 15 minutes and systolic blood pressure was measured every 60 minutes during these interventions.

Results showed that all intervals of sedentary breaks led to significant decreases in systolic blood pressure. The largest reductions in systolic blood pressure occurred in the group that took sedentary breaks every 60 minutes for 1 minute and every 30 minutes for 5 minutes. Similarly, glucose measurements also decreased after sedentary breaks, but the only significant reduction occurred when participants took breaks every 30 minutes for 5 minutes.

This study shows that taking sedentary breaks for different intervals is effective for reducing systolic blood pressure and glucose levels. Higher frequency and longer duration breaks (every 30 minutes for 5 minutes) appears to be most effective for targeting glycemic response, while shorter breaks may be sufficient for lowering blood pressure.

Therefore, if you currently spend most time of the day sitting, it appears that simply getting up for short, light–intensity walking breaks could counteract some of the negative effects of sedentary behavior by improving your glycemic control and blood pressure. But there’s a rule of thumb that also applies here: some is better than none, and more is better than less. So if you’re interested in becoming more physically active but feel that you can use a boost, a physical therapist can help you get there by designing a personalized exercise program based on your body type, abilities, and goals.

Ankle sprains are extremely common, especially for athletes and active individuals. In fact, if you’re athletically involved to any extent, there’s a strong chance that you will sprain your ankle at some point down the road. Ankle sprains account for up to 45% of all sports–related injuries, and approximately 25,000 people sprain their ankle every day. Playing certain sports will also affect your odds, as football, basketball, and soccer have the highest rates of ankle sprains because they involve fast speeds and frequent changes in direction.

The good news is that most ankle sprains are relatively mild, and patients can typically expect to recover and return to their respective activity or sport in a reasonable amount of time; however, recovering from an ankle sprain is not always the end of the story. About 40% of individuals who sprain their ankle will go on to develop chronic ankle instability (CAI), which is a condition that involves persistent instability and an increased risk of experiencing additional ankle sprains due to a combination of impairments. On account of these impairments, patients with CAI may also be at an increased risk for subsequent injuries of the joints proximal to the ankle—the knees, hips, and lower back—because each of these joints influences the movement of the others.

Many experts believe that CAI increases the risk for injury to these proximal joints, but this has not yet been confirmed with research. Therefore, a study was conducted to investigate how many patients who initially suffered an ankle sprain went on to experience any knee, hip, or back issues within the following year, and whether therapeutic exercise had any effect on this relationship.

Medical records of nearly 34,000 military personnel examined over 12 months

Researchers extracted data from the medical records of military personnel in the US Military Health Repository and searched for individuals who experienced an ankle sprain over a two–year period. Medical records of these individuals were then examined to determine if any additional injuries occurred to the knee, hip, or lower back region within the following 12 months. Researchers also looked for data on how many patients underwent therapeutic exercise—such as physical therapy—and whether it affected their risk for experiencing subsequent injuries.

From this search, 33,361 patients who suffered an ankle sprain were identified and included in the study. Of these, 6,848 individuals (20.5%) went on to sustain a secondary injury within the following 12 months, with 40% of these patients having a lower back injury, 39% having a knee injury, and 8% having a hip injury. The remaining patients had a combination of injuries in at least two regions. Further analysis revealed that only 28% of patients were prescribed therapeutic exercise after their initial ankle sprain; however, therapeutic exercise had a protective effect, as these individuals had a lower risk for experiencing a hip injury (32% reduction), lower back injury (18% reduction), or knee (13% reduction) injury.

Although these findings do not prove that ankle sprains directly cause secondary injuries in other joints of the body, they do suggest that there is a relationship between these events, and that ankle sprains appear to be associated with an elevated risk. Furthermore, this study provides evidence that patients who undergo therapeutic exercise after an ankle sprain are less likely to sustain further injury to the hips, knees, or lower back.

We therefore encourage athletes and active individuals to recognize the importance of safely recovering from an ankle sprain and avoiding further exacerbations during this time. Since therapeutic exercise was found to have a protective effect on injury risk, we also recommend seeing a physical therapist if you experience an ankle sprain for a comprehensive rehabilitation program that will help to reduce your risk for future injuries of the ankle and other joints in the region.

Like it or not, injuries are a part of life. And if you’re an athlete or active individual, this fact is more likely to ring true, as you’re bound to experience an injury from time to time—or perhaps even more often.

After an injury occurs, the question that’s top of mind for most athletes is almost always the same: “how long before I can return?” The response to this question from trainers, physical therapists, and other professionals who work with athletes is often something along the lines of “it’s complicated,” which is accurate due to the various factors and nuances involved in each individual injury. However, there are some general concepts and timelines that can help to give you a better idea of what to expect the next time you get injured.

Average healing times for injured structures

Perhaps the most important concept to understand in this discussion is that although proper rehabilitation can significantly reduce pain levels and help patients regain lost physical function, there are limits to how much the recovery process can be sped up. Injuries cause damage and irritation of one or more structures—sometimes extensively—and it can take a fair amount of time for these structures to repair and remodel afterwards. The amount of blood flow to different tissues and structures also varies widely, which directly affects the amount of time needed for healing. Finally, the severity of an injury will—unsurprisingly—impact healing time, with more severe injuries typically taking longer to heal than mild injuries.

For more context, below is a list of the average time for tissue healing of several commonly injured structures based on a comprehensive literature review:

• Muscle strain
  • Grade 1: 2–8 weeks
  • Grade 2: 2–4 months
  • Grade 3: 9–12 months
• Ligament injury
  • Grade 1: 2–8 weeks
  • Grade 2: 2–6 months
  • Grade 3: 9–12 months
  • Surgical repair (eg, ACL): 12+ months
• Tendon injury
  • Acute: 2–6 weeks
  • Subacute: 2–4 months
  • Chronic: 3–9 months
  • Tear, surgical repair, or rupture: 4–12+ months
• Other injuries
  • Bone fracture: 6–12+ weeks
  • Articular cartilage: 9–24 months
  • Meniscus/labrum: 3–12 months

As you can see, the range for healing times is rather wide for some of these injuries—especially severe ones—which highlights the difficulty of predicting an accurate timetable for returning to sports. Other factors that influence healing time include how much the injured area is loaded, inflammation, cardiovascular health, nutrition, hydration, and sleep, as taking good general care of one’s body can speed up the recovery process. It’s also important to recognize that when pain is no longer detected, it doesn’t necessarily mean that the tissue has completely healed or remodeled. And on the flip side, the presence of pain does not necessarily indicate that there is significant tissue damage. Once again, each injury must be examined on a case–by–case basis by an expert who understands how injuries heal and when it’s safe to return to activity.

Physical therapy plays a pivotal role in facilitating recovery

Physical therapists are experts that specialize in helping patients recover from injuries as safely and efficiently as possible. And while we may not have the ability to speed up or change human biology, we do believe that physical therapy can play an essential part in the rehabilitation of most injuries. In each patient encounter we work towards several goals that all contribute to facilitating and expediting injury recovery, including the following:

• Determine an accurate diagnosis and prognosis
• Avoid or modify aggravating factors
• Reduce symptoms, normalize joint motion, minimize swelling
• Address factors that caused the injury or are making it an ongoing problem
• Monitor progress and help with exacerbation and recurrences
• Develop a long–term plan to reduce the risk for injury recurrence

As physical therapists who deal with injured patients constantly, we understand the frustration of not being given an exact timetable after an injury, but as we’ve shown you, predicting healing times is not an exact science. Injuries are tough, and not knowing when you’ll return is sometimes even tougher. But you should take solace in knowing that a physical therapist will always have your best interests and long–term health in mind, and that all decisions will be based on helping to ensure that you can continue doing what you love long into the future.

Nearly 85% of shoulder conditions involve the rotator cuff, and among the most common of these is shoulder impingement syndrome (SIS). SIS results from the rotator cuff tendons becoming compressed—or “impinged”—as they pass through a small bone on top of the shoulder blade called the acromion. Over time, this causes the tendons to become irritated and inflamed, which eventually leads to bothersome symptoms like swelling and tenderness, loss of strength, restricted movement, and pain.

SIS is most common in individuals that regularly perform lots of overhead activities, especially golfers, swimmers, and baseball and tennis players, as well as painters and construction workers. The condition can also result from an injury that compresses the structures of the shoulder—like a fall—or from frequently sleeping on your side regularly, which can strain the shoulder and cause impingement over time.

SIS is closely related to rotator cuff tendinitis and subacromial pain, and in some cases, the terms are used interchangeably. When any of these conditions develop, the best course of action is a comprehensive physical therapy program, which utilizes movement–based treatments to alleviate pain and increase strength, flexibility, and physical function. However, many patients with SIS go to a primary care physician or some other healthcare provider rather than a physical therapist, and while these providers typically do what they think is best for patients, in some cases they prescribe interventions that are costly and/or ineffective for alleviating shoulder pain.

Researchers review three studies comparing injections to physical therapy

One of these interventions is steroid injections, which some healthcare providers use to provide short–term pain relief for conditions like SIS. However, research analyzing the differences between physical therapy and steroid injections is limited, and this led a team of researchers to conduct a study called a systematic review to compare these two interventions.

For the systematic review, investigators searched a major medical database for studies that compared physical therapy to steroid injections for patients with shoulder pain caused by SIS. This search led to three high–quality studies called randomized–controlled trials being included in the review, which featured data on 452 patients.

Results from these three studies revealed that both physical therapy and steroid injections led to improvements in pain, shoulder range of motion (ROM), and shoulder function in the short term (1–3 months), medium term (6 months), and long term (12 months). Although steroid injections were more effective than physical therapy for improving shoulder function in the short term at 6–7 weeks, there were no significant differences between these interventions in pain, shoulder ROM, or shoulder function at the medium–term or long–term follow–ups.

Based on these findings, it appears that both physical therapy and steroid injections provide similar benefits for patients with shoulder pain caused by SIS, with neither intervention found to be superior to the other. Therefore, researchers recommend that patients should be educated on the risks versus benefits of each intervention and given the choice between interventions based on their preference. As a part of this discussion, patients should be informed that physical therapy is generally regarded as a lower–risk treatment option, as evidence on the long–term risks of steroid injections is limited and some studies have found that injections can lead to a compromised immune system and cartilage toxicity over time.

If you’re currently dealing with SIS, we encourage you to explore all treatment options available to you before making a decision. And if you decide that physical therapy is right for you, we’d be more than happy to get you started on a comprehensive treatment program right away.